Reprint Permission Request Form

Please provide the information below to request permission to reprint a text passage or image from a Mazda Publishers book. Permission will be granted for only one print version of your publication and any other use requires additional permission.

Book Title:
Author/Editor:
Publisher:
Nonexclusive Market: [ ] World; [ ] United States; [ ] North America; [ ] Others.
Publication Date:
Format (cloth, paper, both, other):
Number of pages in your publications:
Print run of each edition:
List price of each edition:
If this is a translation request, which language will you be translating into?